En Bloc Breast Implant Removal

Dr. Pancholi performs en bloc breast implant removal whenever possible

Dr. Pancholi is well known for his expertise in breast augmentation and breast implant revision; this includes expertise in breast implant removal, or explantation. There are many details he considers to ensure a safe, successful procedure and an aesthetically pleasing outcome for your new breasts, whether you are getting new implants or not.

One detail Dr. Pancholi will discuss with you is en bloc capsulectomy: removing your breast implants and the surrounding scar tissue all in one piece. Dr. Pancholi strongly prefers this option for breast implant removal, as he feels it’s often best for his patients’ safety and long-term outcomes.

The above photo shows breast implants that Dr. Pancholi removed en bloc to treat capsular contracture. The capsule is fully intact, ensuring no implant material remained in the patient’s body.

What is en bloc capsulectomy and why is it important?

After breast augmentation, your body forms a natural layer of  collagen scar tissue around the breast implant. This is called a capsule. The capsule seals the implant from the rest of your body and provides some structure as well.

During breast implant removal, the surgeon may remove this capsule when they take out the old implants. This is called a capsulectomy. A surgeon can open the capsule, remove the old implant, and then peel the capsule away. Alternatively, the capsule can be peeled away from the surrounding tissues while the implant is still sealed inside; this is called en bloc breast implant removal. When performed en bloc, the body is shielded from the actual implant and its contents. This is particularly important when an implant has ruptured.

Most surgeons will remove the capsule if a patient presents with a complication, such as capsular contracture, BIA-ALCL, or breast implant illness. Dr. Pancholi prefers to remove the old capsule via en bloc capsulectomy when it is safe and appropriate for the patient.

Dr. Pancholi prefers en bloc implant removal for several reasons:

• It’s often the method of choice to remove a silicone implant that may be ruptured. The capsule acts as a barrier between a ruptured implant and your body. If the capsule can be removed with the broken implant still sealed inside, it can serve to keep the surrounding tissues clean and free from any free floating silicone.
• En bloc removal helps to ensure removal of the entire implant shell and contents during explantation. Surgically removing the capsule is one of the most powerful steps in removing the “footprint” of breast implants. The capsule contains cellular and microbial matter, and possibly even silicone particles from a textured implant shell, that may remain after the implant is removed. Removing the capsule en bloc ensures all of this matter is removed thoroughly.
• Reduced risk of complications after breast implant removal. Leaving the capsule behind after implant removal can create a situation where the body seals the opening made to remove an implant and the capsule fills with fluid. This is known as a seroma and can cause issues later on. Removing the capsule drastically reduces these risks.

The above implants, with the capsule opened following explantation. You can see the intact implants inside.

How is en bloc breast implant removal performed?

When performing en bloc breast implant removal, Dr. Pancholi meticulously separates the capsule from the surrounding tissues (breast tissue and muscle) while avoiding puncturing the sometimes paper-thin capsule. This way, the implant is left sealed inside the capsule and together the implant and capsule are removed without exposing the implant to the rest of the body.

Typically, this procedure can be done using your previous breast augmentation incision sites. However, in some cases, Dr. Pancholi may need to make an additional incision to ensure complete removal of the capsule.

En bloc removal is not always possible

Dr. Pancholi performs en bloc removal when he can do so safely; however, not every patient is a good candidate for the procedure. En bloc removal may not be possible if:

• The capsule is too thin and delicate to remove in one piece. In this case, Dr. Pancholi will remove as much of the capsule as possible with the implant and then carefully remove the remaining scar tissue before closing the incisions and/or replacing the implant.
• The breast tissue or skin over the capsule is very thin. For patients with very thin skin, removing the capsule could risk over-thinning of the skin and result in tissue necrosis (tissue death); in such cases, leaving the capsule intact may actually be safer.
• The capsule is adhering to vital tissues. For example, if scar tissue is tightly attached to the rib cage, removing the tissue could risk injuring the lungs.

Removing the capsule can require a more complex surgery, so sometimes it is actually best to leave it alone, especially if Dr. Pancholi feels removing it may introduce new risks to your health or appearance after surgery. Read more from Dr. Pancholi about breast implant replacement and capsule removal on our blog.

Breast implants removed from the capsule after completing en bloc capsulectomy.

Have questions? Call us for more information or to schedule a personal consultation.

Patient safety is Dr. Pancholi’s #1 priority, and he will take all the time you need during your consultation to make sure you understand your options for breast implant removal and replacement, if desired. Please call 702-363-0240 to request more information or schedule your appointment with Dr. Pancholi at Cosmetic Surgery of Las Vegas.